Effective Community Involvement in HIV/AIDS Response

Nearly five million people are living with HIV in Asia with 440,000 people acquiring the infection in 2007 and 300,000 dying from AIDS related illness in the same year. If the current rate of transmission continues an additional eight million people will become newly infected by 2020, costing the region $ 2 billion annually and pushing 6 million people into poverty. HIV could emerge as the leading cause of death among 15 to 44 year olds. However Asian nations could avert increases in infections and death and save millions of people from poverty with high-impact interventions, such as HIV prevention programmes focused on key populations and increased antiretroviral treatment. These were among the findings of the "Redefining AIDS in Asia – Crafting an Effective Response" report published by the Commission on AIDS in Asia (CAA). The report believes that governments in Asia have the potential to make the ambitious international targets – 2001 Declaration of Commitment on HIV/AIDS as well as Millennium Development Goal 6 to halt and reverse the epidemic by 2015 a reality if they take the decisive steps set out in this new report.

The independent Commission on AIDS in Asia was created in June 2006 to give an opportunity to look at the unfolding realities of the HIV epidemic in Asia from a wide socioeconomic perspective reaching beyond the public health context. In order to deliver on this mandate, nine leading economists, scientists, civil society representatives and policy makers from across the region were appointed to the Commission, led by Professor C. Rangarajan, Chief Economic Adviser to the Prime Minister of India. While recognizing that epidemics vary considerably from country to country across Asia, the report highlights certain shared characteristics. Epidemics centre mainly around behaviours of unprotected paid sex, use of contaminated needles and syringes by people who inject drugs, and unprotected sex between men. By pragmatically focusing prevention programmes on key populations – commercial sex workers and their clients, intravenous drug users and men having sex with other men, the commission suggested a considerable impact could be made by governments in halting and reversing the number of new infections across this region.

Noting that stigma against HIV patients remains a major issue in Asia’s health care systems, the commission recommended a more meaningful role for civil society and community-based initiatives. Community organizations of Injecting drug users, sex workers, MSM populations and HIV positive people should be involved and engaged in planning and service delivery. National HIV responses tend to be strengthened when community based organizations are able to participate in policy development, programme planning, and implementation. Community participation is essential for reaching people involved in risky behavior with information and services they are likely to trust. Community participation is the key to understand and influence the contexts in which risk occurs, and to help create supportive environments for risk reduction. This is vital in understanding the issues that affect these populations, and to achieve overall transparency and accountability in the HIV response. Enabling environments need to be created to facilitate services and remove obstacles for most at risk groups.

The report called for political, religious, business and local community leaders to speak out against discrimination, repeal laws that discriminated against men who have sex with men, support HIV-prevention services for sex workers and decriminalize intravenous drug use. Interventions should incorporate elements that address some of the other pressing, subjective needs of beneficiaries such as child care for sex workers, legal support for dealing with police harassment, safe spaces that offer shelter against violence, hygiene and medical facilities for street-based sex workers and IDUs. Further vast social security networks must be created with special attention on vulnerable groups, such as women, children and orphans. Necessary support should be provided for setting up and running local community organizations. National programme budgets must include funding for these activities.

The commission stressed that existing resources are not only inadequate but are currently not being spent on priority interventions that produce an impact. At present, donors provided the lion’s share of funding for such programmes, but Governments really needed to invest more. A focused prevention package between 2008 and 2020 will raise condom use among sex workers to over 80%; halve needle sharing among IDUs; a reduction in cumulative infections by 5 million, a reduction in the number of people living with HIV in 2020 by 3.1 million and a reduction in the number of AIDS related deaths by 40%.

Countries in Asia have the resources, technology and organizational capacity to vastly scale up their response, but strong political will, Government leadership and active community involvement of key populations are lacking. Community and civil society involvement should be ensured at all stages of policy, programme design, implementation and monitoring and evaluation. Communities and non-governmental organizations must take the Commission’s report to their respective Governments to demand the legal protection, policy space and the action necessary to stem the epidemic.

Ishdeep Kohli-CNS